Although we are always glad to work with simple cases, because we look at problems holistically, we often end up evaluating and treating more complex cases, cases which have not responded to a more simple approach elsewhere. These are the more complex cases of impaired attention that did not respond to stimulants, cases complicated by a Learning Disability, an atypical brainwave pattern, or multiple physical imbalances. These are the complex Anxiety or Depression cases where there are multiple other factors contributing to the symptoms. Since we are used to looking at people holistically and used to using a multi-modal treatment approach, we are more comfortable working with these patients. Typically, if a person goes to their doctor complaining of an attentional problem, or a problem with Anxiety or Depression, the doctor will prescribe a medication for that problem. The doctor does not have the tools to determine if this is really biological ADHD, Anxiety, or Depression, or if it is just presenting with those symptoms.
Example: Lets look at someone presenting with all the classic symptoms of Attention Deficit Hyperactivity Disorder. The doctor might ask about drug and alcohol abuse, but not think to ask about coexisting Learning Disabilities, Sensory Integration Disorder, Obsessive Compulsive tendencies, Asperger’s tendencies, head trauma, childhood trauma, significant life stress, poor diet, or poor sleep patterns. If the case is not really biological ADHD or if it is but is complicated by some of these other problems, then they will not respond well to the stimulant. The doctor will then increase the dose. The patient will develop side effects to the stimulant, which is not right for them or too high a dose for them. Often, the doctor will then prescribe another agent to treat the symptoms from the too high dose of stimulant. Sometimes, patients end up on multiple medications, the underlying problem is not really helped, and the other overlooked problems are made worse.
Another common problem is that doctors and patients think that if a little stimulant is good, then more is better. Simulants are unusual because they have what is called an inverted “U” dose response curve. What that means is that as you increase the dose, the response increases but only to a point. As you continue to increase the dose, the symptoms worsen. If the dose is increased too much, the person actually starts to function worse than before they started the medication. This is because too strong a dose down regulates the receptors, making them less responsive to the stimulant. Then, when the stimulant wears off at night or if the person runs out of medication, they are much worse than when they started the medication.
Continuing to use ADHD symptoms as an example, what about the case of true ADHD, but the person also has a coexisting Obsessive Compulsive or Anxiety problem. These other tendencies may not come to the doctor’s attention because they are not that bad. Depending on the brainwave pattern, the stimulant would help the ADHD but could make the Obsessive Compulsive or Anxiety symptoms worse.
The examples given above were to illustrate that many cases are not simple and a simple approach does not work. It is important to look at the whole person, their past, their lifestyle, their relationships, their work or school, their current stress, their thinking patterns, their diet, their substance use, their sleep patterns etc. Naturally, when one looks at a person holistically, there are then many areas to address in a treatment plan. This may sound more complicated, but actually, when you are improving things in all areas of a person’s life, results tend to be better and obviously, there is less need or perhaps no need for medication.
This is only a brief introduction to the issue of complex cases. If you or your family members have been frustrated by poor results, we will do our best to evaluate the situation comprehensively and do our best to provide the best outcome possible.